State prevailing rates

Please note that the CHAMPUS Maximum Allowable Charges (CMAC) take precedence over the state prevailing rates listed below.

Latest update: 08-01-2018
CPT code State Provider class Modifier Current pricing Effective date Past pricing Past effective date
0359T ME 01 00 $500.00 02/16/16
0359T ME 04 00 $500.00 02/16/16
0360T ME 01 00 $62.50 02/16/16
0360T ME 04 00 $62.50 02/16/16
0361T ME 01 00 $62.50 02/16/16
0361T ME 04 00 $62.50 02/16/16
0364T ME 01 00 $62.50 05/24/17
0364T ME 04 00 $62.50 05/24/17
0365T ME 01 00 $62.50 02/16/16
0365T ME 04 00 $62.50 02/16/16
0368T ME 01 00 $62.50 02/16/16
0368T ME 04 00 $62.50 02/16/16
0369T ME 01 00 $62.50 02/16/16
0369T ME 04 00 $62.50 02/16/16
0370T ME 01 00 $125.00 02/16/16
0370T ME 04 00 $125.00 02/16/16
15824 ME 01 00 $343.40 05/24/17
15824 ME 04 00 $343.40 05/24/17
15825 ME 01 00 $343.40 05/24/17
15825 ME 04 00 $343.40 05/24/17
15826 ME 01 00 $343.40 05/24/17
15826 ME 04 00 $343.40 05/24/17
15828 ME 01 00 $343.40 05/24/17
15828 ME 04 00 $343.40 05/24/17
15829 ME 01 00 $343.40 05/24/17
15829 ME 04 00 $343.40 05/24/17
15876 ME 01 00 $343.40 05/24/17
15876 ME 04 00 $343.40 05/24/17
15878 ME 01 00 $343.40 05/24/17
15878 ME 04 00 $343.40 05/24/17
15879 ME 01 00 $343.40 05/24/17
15879 ME 04 00 $343.40 05/24/17
17380 ME 01 00 $343.40 02/16/16
17380 ME 04 00 $343.40 02/16/16
21088 ME 01 00 $343.40 02/16/16
21088 ME 04 00 $343.40 02/16/16
21089 ME 01 00 $343.40 05/24/17
21089 ME 04 00 $343.40 05/24/17
22841 ME 01 00 $343.40 05/24/17
22841 ME 04 00 $343.40 05/24/17
24940 ME 01 00 $343.40 05/24/17
24940 ME 04 00 $343.40 05/24/17
26989 ME 01 00 $343.40 05/24/17
26989 ME 04 00 $343.40 05/24/17
32850 ME 01 00 $343.40 05/24/17
32850 ME 04 00 $343.40 05/24/17
33930 ME 01 00 $343.40 05/24/17
33930 ME 04 00 $343.40 05/24/17
33940 ME 01 00 $343.40 05/24/17
33940 ME 04 00 $343.40 05/24/17
41821 ME 01 00 $343.40 05/24/17
41821 ME 04 00 $343.40 05/24/17
41870 ME 01 00 $343.40 05/24/17
41870 ME 04 00 $343.40 05/24/17
43496 ME 01 00 $343.40 05/24/17
43496 ME 04 00 $343.40 05/24/17
47133 ME 01 00 $343.40 05/24/17
47133 ME 04 00 $343.40 05/24/17
48160 ME 01 00 $343.40 05/24/17
48160 ME 04 00 $343.40 05/24/17
48550 ME 01 00 $343.40 05/24/17
48550 ME 04 00 $343.40 05/24/17
49906 ME 01 00 $343.40 05/24/17
49906 ME 04 00 $343.40 05/24/17
50300 ME 01 00 $343.40 05/24/17
50300 ME 04 00 $343.40 05/24/17
55970 ME 01 00 $343.40 05/24/17
55970 ME 04 00 $343.40 05/24/17
55980 ME 01 00 $343.40 05/24/17
55980 ME 04 00 $343.40 05/24/17
58974 ME 01 00 $343.40 02/16/16
58974 ME 04 00 $343.40 02/16/16
65767 ME 01 00 $343.40 05/24/17
65767 ME 04 00 $343.40 05/24/17
65771 ME 01 00 $343.40 02/16/16
65771 ME 04 00 $343.40 02/16/16
69090 ME 01 00 $343.40 02/16/16
69090 ME 04 00 $343.40 02/16/16
69710 ME 01 00 $343.40 02/16/16
69710 ME 04 00 $343.40 02/16/16
69949 ME 01 00 $343.40 05/24/17
69949 ME 04 00 $343.40 05/24/17
69979 ME 01 00 $343.40 05/24/17
69979 ME 04 00 $343.40 05/24/17
76001 ME 01 00 $811.00 04/20/17 $758.00 08/21/15
76001 ME 01 TC $492.02 05/24/17
76001 ME 04 00 $524.40 05/24/17
76001 ME 04 TC $492.02 05/24/17
78609 ME 01 00 $343.40 05/24/17
78609 ME 04 00 $343.40 05/24/17
79300 ME 01 00 $343.40 05/24/17
79300 ME 04 00 $343.40 05/24/17
86860 ME 01 00 $54.00 05/24/17
86860 ME 04 00 $54.00 05/24/17
86891 ME 01 00 $90.00 05/24/17
86891 ME 04 00 $90.00 05/24/17
86930 ME 01 00 $9.00 05/24/17
86930 ME 04 00 $9.00 05/24/17
86931 ME 01 00 $9.00 05/24/17
86931 ME 04 00 $9.00 05/24/17
86932 ME 01 00 $9.00 05/24/17
86932 ME 04 00 $9.00 05/24/17
86950 ME 01 00 $45.00 05/24/17
86950 ME 04 00 $45.00 05/24/17
86970 ME 01 00 $144.00 05/24/17
86970 ME 04 00 $144.00 05/24/17
86971 ME 01 00 $144.00 05/24/17
86971 ME 04 00 $144.00 05/24/17
86972 ME 01 00 $144.00 05/24/17
86972 ME 04 00 $144.00 05/24/17
86975 ME 01 00 $144.00 05/24/17
86975 ME 04 00 $144.00 05/24/17
86976 ME 01 00 $144.00 05/24/17
86976 ME 04 00 $144.00 05/24/17
86977 ME 01 00 $144.00 05/24/17
86977 ME 04 00 $144.00 05/24/17
86978 ME 01 00 $144.00 05/24/17
86978 ME 04 00 $144.00 05/24/17
90736 ME 01 00 $254.35 07/20/17
90736 ME 04 00 $254.35 07/20/17
90993 ME 01 00 $343.40 05/24/17
90993 ME 04 00 $343.40 05/24/17
92993 ME 01 00 $343.40 05/24/17
92993 ME 04 00 $343.40 05/24/17
99000 ME 01 00 $24.00 04/20/17
99000 ME 04 00 $24.00 04/20/17
99001 ME 01 00 $37.95 04/20/17
99001 ME 04 00 $37.95 04/20/17
99071 ME 01 00 $1.80 02/16/16
99071 ME 04 00 $1.80 02/16/16
99075 ME 01 00 $1.80 02/16/16
99075 ME 04 00 $1.80 02/16/16
99455 ME 01 00 $343.40 02/16/16
99455 ME 04 00 $343.40 02/16/16
A0225 ME 01 00 $235.00 05/24/17
A0225 ME 04 00 $235.00 05/24/17
A0431 ME 01 00 $2,364.68 04/09/18 $2,781.98 12/08/16
A0431 ME 01 00 $3,272.93 12/10/15
A0431 ME 04 00 $2,364.68 04/09/18 $2,781.98 12/08/16
A0431 ME 04 00 $3,272.93 12/10/15
A0436 ME 01 00 $15.86 04/09/18 $18.66 12/08/16
A0436 ME 01 00 $21.95 12/10/15
A0436 ME 04 00 $15.86 04/09/18 $18.66 12/08/16
A0436 ME 04 00 $21.95 12/10/15
A4206 ME 01 00 $.33 05/24/17
A4206 ME 04 00 $.33 05/24/17
A4208 ME 01 00 $.27 05/24/17
A4208 ME 04 00 $.27 05/24/17
A4209 ME 01 00 $3.05 05/24/17
A4209 ME 04 00 $3.05 05/24/17
A4212 ME 01 00 $5.00 05/24/17
A4212 ME 04 00 $5.00 05/24/17
A4213 ME 01 00 $2.60 05/24/17
A4213 ME 04 00 $2.60 05/24/17
A4215 ME 01 00 $22.00 05/24/17 $20.80 08/28/15
A4215 ME 04 00 $22.00 05/24/17 $20.80 08/28/15
A4218 ME 01 00 $.58 05/24/17
A4218 ME 04 00 $.58 05/24/17
A4245 ME 01 00 $6.72 05/24/17
A4245 ME 04 00 $6.72 05/24/17
A4263 ME 01 00 $95.00 05/24/17
A4263 ME 04 00 $95.00 05/24/17
A4550 ME 01 00 $52.00 04/20/17 $50.00 08/29/15
A4550 ME 04 00 $52.00 04/20/17 $50.00 08/29/15
A4570 ME 01 00 $17.00 05/24/17
A4570 ME 04 00 $17.00 05/24/17
A4580 ME 01 00 $110.00 05/24/17
A4580 ME 04 00 $110.00 05/24/17
A4590 ME 01 00 $99.00 05/24/17
A4590 ME 04 00 $99.00 05/24/17
A4627 ME 01 00 $80.00 05/24/17
A4627 ME 04 00 $80.00 05/24/17
A4770 ME 01 00 $160.00 05/24/17
A4770 ME 04 00 $160.00 05/24/17
A4927 ME 01 00 $16.14 05/24/17
A4927 ME 04 00 $16.14 05/24/17
A6208 ME 01 00 $67.11 05/24/17
A6208 ME 04 00 $67.11 05/24/17
A6213 ME 01 00 $9.80 05/24/17
A6213 ME 04 00 $9.80 05/24/17
A6451 ME 01 00 $1.99 05/24/17
A6451 ME 04 00 $1.99 05/24/17
A9282 ME 01 00 $2,000.00 05/24/17
A9282 ME 04 00 $2,000.00 05/24/17
A9500 ME 01 00 $397.00 04/20/17 $278.00 09/01/15
A9500 ME 04 00 $125.00 05/24/17
A9502 ME 01 00 $423.00 05/24/17 $376.00 09/01/15
A9502 ME 04 00 $208.00 05/24/17
A9503 ME 01 00 $223.00 04/20/17 $214.25 09/02/15
A9503 ME 04 00 $132.00 05/24/17
A9505 ME 01 00 $31.74 05/24/17
A9505 ME 04 00 $31.74 05/24/17
A9507 ME 01 00 $3,244.35 05/24/17
A9507 ME 04 00 $3,244.35 05/24/17
A9510 ME 01 00 $327.50 05/24/17
A9510 ME 04 00 $327.50 05/24/17
A9516 ME 01 00 $268.00 05/24/17
A9516 ME 04 00 $68.45 05/24/17
A9517 ME 01 00 $33.31 05/24/17
A9517 ME 04 00 $33.31 05/24/17
A9521 ME 01 00 $567.61 05/24/17
A9521 ME 04 00 $567.61 05/24/17
A9530 ME 01 00 $28.91 05/24/17
A9530 ME 04 00 $28.91 05/24/17
A9537 ME 01 00 $254.65 04/20/17
A9537 ME 04 00 $59.54 05/24/17
A9538 ME 01 00 $24.70 05/24/17
A9538 ME 04 00 $24.70 05/24/17
A9539 ME 01 00 $16.25 05/24/17
A9539 ME 04 00 $16.25 05/24/17
A9541 ME 01 00 $231.50 05/24/17 $203.00 09/16/15
A9541 ME 04 00 $75.35 05/24/17
A9542 ME 01 00 $2,769.63 05/24/17
A9542 ME 04 00 $2,769.63 05/24/17
A9551 ME 01 00 $126.63 05/24/17
A9551 ME 04 00 $126.63 05/24/17
A9552 ME 01 00 $1,436.00 04/20/17 $1,044.00 09/16/15
A9552 ME 04 00 $900.00 05/24/17
A9556 ME 01 00 $32.04 05/24/17
A9556 ME 04 00 $32.04 05/24/17
A9558 ME 01 00 $38.96 05/24/17
A9558 ME 04 00 $38.96 05/24/17
A9560 ME 01 00 $114.00 05/24/17
A9560 ME 04 00 $114.00 05/24/17
A9561 ME 01 00 $34.56 05/24/17
A9561 ME 04 00 $34.56 05/24/17
A9562 ME 01 00 $445.51 05/24/17
A9562 ME 04 00 $445.51 05/24/17
A9600 ME 01 00 $1,014.13 05/24/17
A9600 ME 04 00 $1,014.13 05/24/17
A9700 ME 01 00 $149.00 05/24/17
A9700 ME 04 00 $149.00 05/24/17
B4172 ME 01 00 $195.00 05/24/17
B4172 ME 04 00 $195.00 05/24/17
B5200 ME 01 00 $4.94 05/24/17
B5200 ME 04 00 $4.94 05/24/17
C1713 ME 01 00 $795.00 05/24/17
C1713 ME 04 00 $795.00 05/24/17
C1769 ME 01 00 $549.50 05/24/17
C1769 ME 04 00 $549.50 05/24/17
C1781 ME 01 00 $1,769.00 05/24/17
C1781 ME 04 00 $1,769.00 05/24/17
C1887 ME 01 00 $379.00 05/24/17
C1887 ME 04 00 $379.00 05/24/17
C8908 ME 01 00 $599.40 05/24/17
C8908 ME 04 00 $599.40 05/24/17
C9113 ME 01 00 $58.56 05/24/17 $53.52 09/23/15
C9113 ME 04 00 $30.00 05/24/17
D7230 ME 01 00 $448.00 04/20/17
D7230 ME 04 00 $275.00 05/24/17
D7240 ME 01 00 $450.00 04/20/17
D7240 ME 04 00 $450.00 04/20/17
E0246 ME 01 00 $63.00 02/16/16
E0246 ME 01 RR $5.25 02/16/16
E0246 ME 04 00 $63.00 02/16/16
E0246 ME 04 RR $5.25 02/16/16
E0270 ME 01 00 $6,500.00 05/24/17
E0270 ME 01 RR $541.67 05/24/17
E0270 ME 04 00 $6,500.00 05/24/17
E0270 ME 04 RR $541.67 05/24/17
E0352 ME 01 00 $45.53 05/24/17
E0352 ME 04 00 $45.53 05/24/17
E0430 ME 01 00 $315.00 05/24/17
E0430 ME 01 RR $26.25 05/24/17
E0430 ME 04 00 $315.00 05/24/17
E0430 ME 04 RR $26.25 05/24/17
E0435 ME 01 00 $3,700.00 05/24/17
E0435 ME 01 NU $3,700.00 05/24/17
E0435 ME 04 00 $3,700.00 05/24/17
E0435 ME 04 NU $3,700.00 05/24/17
E0440 ME 01 00 $3,706.50 05/24/17
E0440 ME 01 NU $3,706.50 05/24/17
E0440 ME 04 00 $3,706.50 05/24/17
E0440 ME 04 NU $3,706.50 05/24/17
E0445 ME 01 RR $1,282.31 04/20/17
E0445 ME 04 RR $1,282.31 04/20/17
E0455 ME 01 00 $2,750.00 05/24/17
E0455 ME 01 RR $229.17 05/24/17
E0455 ME 04 00 $2,750.00 05/24/17
E0455 ME 04 RR $229.17 05/24/17
E0700 ME 01 00 $32.00 05/24/17
E0700 ME 01 RR $2.67 05/24/17
E0700 ME 04 00 $32.00 05/24/17
E0700 ME 04 RR $2.67 05/24/17
E0710 ME 01 00 $12.00 05/24/17
E0710 ME 01 RR $1.00 05/24/17
E0710 ME 04 00 $12.00 05/24/17
E0710 ME 04 RR $1.00 05/24/17
E0970 ME 01 00 $41.10 05/24/17
E0970 ME 01 RR $3.43 05/24/17
E0970 ME 04 00 $41.10 05/24/17
E0970 ME 04 RR $3.43 05/24/17
E1085 ME 01 00 $750.00 05/24/17
E1085 ME 01 NU $750.00 05/24/17
E1085 ME 01 RR $62.50 05/24/17
E1085 ME 04 00 $750.00 05/24/17
E1085 ME 04 NU $750.00 05/24/17
E1085 ME 04 RR $62.50 05/24/17
E1086 ME 01 00 $838.00 05/24/17
E1086 ME 01 NU $838.00 05/24/17
E1086 ME 01 RR $69.83 05/24/17
E1086 ME 04 00 $838.00 05/24/17
E1086 ME 04 NU $838.00 05/24/17
E1086 ME 04 RR $69.83 05/24/17
E1089 ME 01 00 $1,200.00 05/24/17
E1089 ME 01 RR $100.00 05/24/17
E1089 ME 04 00 $1,200.00 05/24/17
E1089 ME 04 RR $100.00 05/24/17
E1090 ME 01 00 $880.00 05/24/17
E1090 ME 01 NU $880.00 05/24/17
E1090 ME 01 RR $73.33 05/24/17
E1090 ME 04 00 $880.00 05/24/17
E1090 ME 04 NU $880.00 05/24/17
E1090 ME 04 RR $73.33 05/24/17
E1130 ME 01 00 $475.00 05/24/17
E1130 ME 01 NU $475.00 05/24/17
E1130 ME 01 RR $39.58 05/24/17
E1130 ME 04 00 $475.00 05/24/17
E1130 ME 04 NU $475.00 05/24/17
E1130 ME 04 RR $39.58 05/24/17
E1140 ME 01 00 $784.00 05/24/17
E1140 ME 01 NU $784.00 05/24/17
E1140 ME 01 RR $65.33 05/24/17
E1140 ME 04 00 $784.00 05/24/17
E1140 ME 04 NU $784.00 05/24/17
E1140 ME 04 RR $65.33 05/24/17
E1250 ME 01 00 $860.30 05/24/17
E1250 ME 01 NU $860.30 05/24/17
E1250 ME 01 RR $71.69 05/24/17
E1250 ME 04 00 $860.30 05/24/17
E1250 ME 04 NU $860.30 05/24/17
E1250 ME 04 RR $71.69 05/24/17
E1260 ME 01 00 $887.00 05/24/17
E1260 ME 01 NU $887.00 05/24/17
E1260 ME 01 RR $73.92 05/24/17
E1260 ME 04 00 $887.00 05/24/17
E1260 ME 04 NU $887.00 05/24/17
E1260 ME 04 RR $73.92 05/24/17
E1285 ME 01 00 $1,500.00 05/24/17
E1285 ME 01 NU $1,500.00 05/24/17
E1285 ME 01 RR $125.00 05/24/17
E1285 ME 04 00 $1,500.00 05/24/17
E1285 ME 04 NU $1,500.00 05/24/17
E1285 ME 04 RR $125.00 05/24/17
E1290 ME 01 00 $1,500.00 05/24/17
E1290 ME 01 NU $1,500.00 05/24/17
E1290 ME 04 00 $1,500.00 05/24/17
E1290 ME 04 NU $1,500.00 05/24/17
E1353 ME 01 RR $54.17 05/24/17
E1353 ME 04 RR $54.17 05/24/17
E1355 ME 01 RR $3.67 05/24/17
E1355 ME 04 RR $3.67 05/24/17
G8539 ME 01 00 $31.25 05/24/17
G8539 ME 04 00 $31.25 05/24/17
G8542 ME 01 00 $31.25 05/24/17
G8542 ME 04 00 $31.25 05/24/17
H0015 ME 01 00 $276.00 09/18/17 $262.00 02/24/16
H0015 ME 01 00 $262.00 02/24/16
H0015 ME 04 00 $276.00 09/18/17 $262.00 02/24/16
H0015 ME 04 00 $262.00 02/24/16
H0035 ME 01 00 $262.00 09/22/15 $248.00 01/03/14
H0035 ME 01 00 $276.00 09/18/17 $262.00 09/22/15
H0035 ME 04 00 $262.00 09/22/15 $248.00 01/03/14
H0035 ME 04 00 $276.00 09/18/17 $262.00 09/22/15
H0037 ME 01 00 $349.00 09/22/15 $331.00 01/03/14
H0037 ME 01 00 $368.00 09/18/17 $349.00 09/22/15
H0037 ME 04 00 $349.00 09/22/15 $331.00 01/03/14
H0037 ME 04 00 $368.00 09/18/17 $349.00 09/22/15
H2019 ME 01 00 $18.75 05/24/17
H2019 ME 04 00 $12.50 05/24/17
K0739 ME 01 00 $24.83 12/01/15 $24.30 12/19/13
K0739 ME 01 00 $25.48 01/24/18 $25.08 12/29/16
K0739 ME 04 00 $24.83 12/01/15 $24.30 12/19/13
K0739 ME 04 00 $25.48 01/24/18 $25.08 12/29/16
L3260 ME 01 00 $40.00 04/20/17
L3260 ME 04 00 $40.00 04/20/17
L3265 ME 01 00 $20.00 02/16/16
L3265 ME 04 00 $20.00 02/16/16
L4205 ME 01 00 $22.13 12/01/15 $21.66 12/19/13
L4205 ME 01 00 $22.71 01/24/18 $22.35 12/29/16
L4205 ME 04 00 $22.13 12/01/15 $21.66 12/19/13
L4205 ME 04 00 $22.71 01/24/18 $22.35 12/29/16
L7520 ME 01 00 $30.08 12/01/15 $29.43 12/19/13
L7520 ME 01 00 $30.87 01/24/18 $30.38 12/29/16
L7520 ME 04 00 $30.08 12/01/15 $29.43 12/19/13
L7520 ME 04 00 $30.87 01/24/18 $30.38 12/29/16
Q0081 ME 01 00 $232.00 05/24/17
Q0081 ME 04 00 $232.00 05/24/17
R0070 ME 01 00 $140.00 05/24/17
R0070 ME 04 00 $140.00 05/24/17
S5108 ME 01 00 $31.25 05/24/17
S5108 ME 04 00 $31.25 05/24/17
S5110 ME 01 00 $31.25 05/24/17
S5110 ME 04 00 $31.25 05/24/17
S5115 ME 01 00 $31.25 05/24/17
S5115 ME 04 00 $31.25 05/24/17
S9430 ME 01 00 $500.00 05/24/17
S9430 ME 04 00 $100.00 05/24/17
S9480 ME 01 00 $276.00 09/18/17 $262.00 02/24/16
S9480 ME 01 00 $262.00 02/24/16
S9480 ME 04 00 $276.00 09/18/17 $262.00 02/24/16
S9480 ME 04 00 $262.00 02/24/16
V2781 ME 01 00 $225.00 05/24/17
V2781 ME 04 00 $225.00 05/24/17
V5264 ME 01 00 $14.85 05/24/17
V5264 ME 04 00 $14.85 05/24/17